Effectiveness of non-surgical and surgical interventions for elbow flexion contractures in brachial plexus birth injury: A systematic review

Ho, Emily S.; Zuccaro, Jennifer; Klar, Karen; Anthony, Alison; Davidge, Kristen M.; Borschel, Gregory H.; Hopyan, Sevan; Clarke, Howard M.; Wright, F. Virginia

doi:10.3233/prm-180563

Cited by 4 publications

(16 citation statements)

References 29 publications

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“…Information on the natural history, prevalence, and range in severity of elbow contractures that was synthesized in a recent scoping review 4 was presented graphically in the introduction of the PtDA, and the common functional and appearance‐related concerns were illustrated as experiences shared by the participants. Next, the three distinct treatment options that emerged from a systematic review 6 were described alongside their expected outcomes and potential risks: (1) watch and wait, (2) stretching program, and (3) elbow release surgery. The PtDA was designed to present the options information in a balanced and unbiased manner 42,43 .…”

Section: Resultsmentioning

confidence: 99%

“…5 Elbow contractures are typically treated conservatively with rehabilitation interventions such as serial casting and nighttime splinting before consideration of more invasive interventions. 6 An example of one such rehabilitation program is passive elbow range of motion (ROM) exercises, followed by an application of a long arm fiberglass or plaster cast to hold the elbow at maximum extension. Most typically, the cast is removed after a week and the process of stretching and casting is repeated until extension ROM is optimized.…”

Section: Introductionmentioning

confidence: 99%

“…Second, the overall risks of loss in elbow flexion ROM and strength that are associated with rehabilitation or surgical interventions are unclear. 6,10 Elbow flexion is critical for activities of daily living (eg, hand to mouth function). As a result, the decision to pursue rehabilitation or surgical intervention requires careful weighing of the risks and benefits of treatment within the context of the youth's and family's goals.…”

Section: Introductionmentioning

confidence: 99%

“…The overall evidence for the effectiveness of both rehabilitation and surgical intervention for elbow flexion contractures is weak but demonstrates that significant gains in reducing the contracture may be achieved with serial casting or elbow release surgery 6 . However, there are known challenges and risks with these interventions.…”

Section: Introductionmentioning

confidence: 99%

“…Even in the best case scenarios, complete restoration of elbow extension to full passive and active ROM after rehabilitation or surgical intervention is unlikely. Second, the overall risks of loss in elbow flexion ROM and strength that are associated with rehabilitation or surgical interventions are unclear 6,10 . Elbow flexion is critical for activities of daily living (eg, hand to mouth function).…”

Section: Introductionmentioning

confidence: 99%

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Developing a decision aid for youth with brachial plexus birth injuries facing treatment decisions for an elbow flexion contracture

Parsons

Davidge

et al. 2021

PM&R

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Background A common sequela of brachial plexus birth injury (BPBI) is an elbow flexion contracture. Youth with BPBI and their families face rehabilitation or surgical decisions that ideally entail careful deliberation of the risks and benefits of treatment within the context of the child's and family's functional and appearance‐related goals. Objective To develop a patient decision aid (PtDA) following International Patient Decision Aid Standards to help these youth and their families make treatment decisions. Design Mixed‐methods study. Setting Brachial plexus clinic in a pediatric tertiary care center. Participants Five young adults (21–24 years), 14 youth (8–19 years) and their parents, 15 families (children 2–16 years), and 19 clinicians from a brachial plexus clinic participated in the PtDA development. Seventeen other youth (8–18 years) facing treatment decisions regarding their elbow contracture field tested the PtDA prototype. Interventions Not applicable. Main Outcome Measures In‐depth interviews and participant observation to conduct a decisional needs assessment of young adults, youth, parents, and health care professionals involved in these shared decisions. Cognitive interviews to field test the PtDA prototype. Results Evidence from previously conducted knowledge synthesis and the youth‐focused decisional needs assessment qualitative data informed the development of new PtDA prototype, which included a questionnaire‐based values clarification method for youth to rate what matters most to them regarding their elbow function, appearance, psychosocial impact, and treatment options. The majority (90%) of youth >11 years who field tested the PtDA prototype understood its content, whereas only 29% of those between 8 and 11 years demonstrated independent comprehension. The majority (69%) responded that they would prefer to use the PtDA on their own either at home or in the clinic waiting room. Conclusions This new PtDA can be used to help youth with BPBI and their families to make a personal value‐based informed decision regarding treatment options for their elbow flexion contracture.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Developing a decision aid for youth with brachial plexus birth injuries facing treatment decisions for an elbow flexion contracture

Parsons

Davidge

et al. 2021

PM&R

Self Cite

View full text Add to dashboard Cite

show abstract

Shared decision making in youth with brachial plexus birth injuries and their families: A qualitative study

Parsons

Davidge

et al. 2021

Patient Education and Counseling

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Elbow flexion contractures in neonatal brachial plexus palsy: A one-year comparison of dynamic orthosis and serial casting

Coul

Bleeker²,

Groot

et al. 2022

Clin Rehabil

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Objective Elbow flexion contractures are common complications of neonatal brachial plexus palsy, but evidence on how to treat these contractures is weak. This study compared the treatment of elbow flexion contractures using a dynamic orthosis or serial circular casting. Methods A randomized controlled trial was conducted with one-year follow-up. Children with an elbow flexion contracture of ≥30° were treated with either a night-worn dynamic orthosis for one year or serial casting for four weeks followed by night splinting. For pragmatic reasons, some participants were included in an open part of this study, this group was also analyzed separately. Degree of contracture and goal attainment scaling was evaluated at baseline and after 8, 20 and 54 weeks. Results 55 patients were analyzed in this trial, 32 of whom were randomized to treatment. At one-year follow-up of the randomized group, both dynamic splinting (median −8.5°, interquartile range [IQR] −13.5, −5) and serial casting (median −11.0°, IQR −16, −5) resulted in significant reduction of contracture ( P < 0 .001). The reduction was significantly greater with serial casting in the first 20 weeks, but not at one-year follow-up ( P = 0.683). In the entire cohort, the individual functional goals had been reached in 24 out of 32 cases (80%) of dynamic splinting and 18 out of 23 cases (82%) of serial casting, respectively. Conclusion The dynamic night orthosis is comparable to serial casting for treating elbow flexion contractures in children with brachial plexus birth injury. We recommend selecting one of these treatment modalities in close consultation with parents and patients.

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Effectiveness of non-surgical and surgical interventions for elbow flexion contractures in brachial plexus birth injury: A systematic review

Cited by 4 publications

References 29 publications

Developing a decision aid for youth with brachial plexus birth injuries facing treatment decisions for an elbow flexion contracture

Developing a decision aid for youth with brachial plexus birth injuries facing treatment decisions for an elbow flexion contracture

Shared decision making in youth with brachial plexus birth injuries and their families: A qualitative study

Elbow flexion contractures in neonatal brachial plexus palsy: A one-year comparison of dynamic orthosis and serial casting

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